HEALTHCARE

Healthcare

States spend more than $200 billion annually for health care for the poor and medically needy, according to the State Budget Crisis Task Force.

Medicaid has taken up a larger share of state budgets in recent years, with the program's expenses totaling approximately one quarter of total state expenditures, according to the National Association of State Budget Officers. This has a dual effect on state budgets during economic downturns, as states face an increasing demand for Medicaid services while the revenue available to pay for those services declines. New York spends $54 billion per year on Medicaid, the most of any state.

The impact of Obamacare on state budgets remains to be seen, and governors have had varied responses to the Supreme Court decision upholding the law which would increase the number of Medicaid enrollees, but not penalize the states that do not participate.

HEADLINES: Virginia

Virginia's protracted budget dispute has taken a surprising turn for the worse. New tax data suggests a $300 million shortfall this fiscal year, and that could compel fractious legislators to redouble efforts to find an elusive compromise.

HEADLINES: California

Enrollment in the state's healthcare program for the poor has soared past expectations as a result of President Obama's federal overhaul, Gov. Jerry Brown said Tuesday, and by next year about a third of Californians will be covered, costing hundreds of millions of dollars more than anticipated.

HEADLINES: Louisiana

Since the Legislature received the Republican governor's recommendations, worries have been raised by federal rejection of financing for the LSU hospital privatization deals already put in place by Jindal and largely funded with federal money.

HEADLINES: Virginia

Frustrated Virginia legislative Republicans accused Democrats of state budget brinkmanship after one Democratic senator in published remarks said he's willing to overshoot a key fiscal deadline to get concessions on Medicaid expansion.

RESEARCH

Electronic cigarettes (e-cigs) have only been around since 2006, yet their potential to dramatically reduce the damaging health impacts of traditional cigarettes has garnered significant attention and credibility.

POLICY BRIEF: Virginia

Virginia's Medicaid commission is considering expansion, and this report explains some of the current problems with Medicaid coverage, anticipated problems with accepting Medicaid expansion and discuss alternatives and reforms that will better serve Virginians.

RESEARCH

In the wake of a 2012 Supreme Court ruling, states face complex decisions con cerning whether to expand Medicaid coverage as specified in the Affordable Care Act (ACA). With the federal government no longer able to coerce expansion, states must base their decisions on subjective value judgments that will vary from state to state, incorporating each state's unique budgetary circumstances, the needs of its uninsured population, and the incentives established by interactions between the ACA's provisions. A first important consideration is that states face substantial near-term Medicaid cost increases irrespective of coverage expansion decisions.

RESEARCH

The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, made significant changes to the way eligibility for the Medicaid program will be determined and who the program will cover. State governments will play a key role in implementing many aspects of this reform, which must be in place by the beginning of 2014. States will need to address the financial implications of implementing this Medicaid expansion and accompanying enrollment systems.

RESEARCH

State finances are not transparent and often include hidden liabilities as well as rapidly growing responsibilities which are difficult to control. While state revenues are gradually recovering from the drastic decline of the Great Recession, they are not growing sufficiently to keep pace with the spending required by Medicaid costs, pensions, and other responsibilities and obligations. This has resulted in persistent and growing structural deficits in many states which threaten their fiscal sustainability.

RESEARCH

In the long term, the decline in the sector's operating balance is primarily driven by the rising health-related costs of state and local expenditures on Medicaid and the cost of health care compensation for state and local government employees and retirees.

SOLUTIONS: California

This paper examines the ongoing fiscal crisis caused by health-care plans for retirees (known as "other post-employment benefits," or OPEB) in one of the hardest-hit states, California, and outlines necessary reforms that should come before tax increases or cuts to government services.

SOLUTIONS

Supporters of Obamacare claim that expanding Medicaid will entail little to no cost to state governments, since the federal government will fund the vast majority of the additional costs. Indeed, some analyses project states achieving savings from adopting the expansion. However, state lawmakers should be wary of accepting such analyses at face value.

SOLUTIONS: North Carolina

With some reasonable reforms to the program to make the State Health Plan benefits more closely aligned with those offered in the private sector and other state governments, however, the state can put the State Health Plan back onto a sustainable path.

SOLUTIONS: North Carolina , Florida

Any serious attempt at state budget reform in North Carolina must include an examination of its Medicaid program. Costs have been soaring, and past cost-containment efforts have proven both insufficient and detrimental to enrollees' access to care. Moreover, Medicaid enrollees are merely passive participants in the program with little or no choices, and at the mercy of the whims of politicians.

SOLUTIONS: Florida

Foundation for Government Accountability | by Tarren Bragdon | May 23, 2012

During its five years of operations, Florida's Medicaid Reform Pilot has improved the health of enrolled patients, achieved high patient satisfaction, and kept cost increases below average, saving Florida up to $118 million annually.

SOLUTIONS: Georgia, North Carolina

Medicaid services not required by the federal government but approved by the state legislature in years past cost North Carolin $4.4 billion in 2010-2011. That accounted for 46 percent of the state's $10 billion Medicaid budget.

SOLUTIONS: Rhode Island, Florida, Idaho, Tennessee, Washington

To better understand best practices in Medicaid reform, we explore five recent state-level Medicaid reforms and their ability to simultaneously reduce costs, maintain or increase access, and survive the politics of reform.

SOLUTIONS

The Health Care Compact is an interstate compact - which is really just "an agreement between two or more states that is consented to by Congress" - that would return the authority and the responsibility to regulate health care back to the member states.

BLOG: Missouri, Arkansas

Jefferson City, Missouri and Little Rock, Arkansas are not geographically far apart, but there's a world of difference in how the legislatures meeting in those cities handle medical care for their most vulnerable residents.

BLOG

One look at the upcoming cases before the Supreme Court and the federal courts of appeal would suggest that states and the national government have a destructively adversarial relationship. Should we be worried about this constant conflict?

BLOG

The bombshell Oregon Medicaid study released this week should give all states pause as they consider plans to expand Medicaid under the Affordable Care Act. States must now ask what the point of Medicaid is in the first place.